Long-head biceps tendon rupture as a complication of brucellar tenosynovitis: a rare manifestation of multifocal osteoarticular brucellosis
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20262069Keywords:
Brucellosis, Brucella melitensis, Spondylodiscitis, Septic arthritis, Shoulder, Long-head biceps, Tenosynovitis, Tendon rupture, Camel milkAbstract
Brucellosis is a major zoonotic infection in endemic regions and can cause focal osteoarticular complications. Spinal involvement and peripheral septic arthritis are recognised manifestations; however, glenohumeral septic arthritis complicated by long-head biceps (LHB) infective tenosynovitis and tendon rupture is exceedingly rare. A 69-year-old immunocompetent man presented with severe low back pain and right shoulder pain without fever. Initial imaging suggested degenerative lumbar disease and the patient was treated conservatively. One week later, he returned with fever, night sweats, anorexia, worsening bilateral sciatica, and markedly restricted shoulder motion. Inflammatory markers were significantly elevated (CRP 121 mg/l; ESR 74 mm/h), and aerobic blood culture grew Brucella spp., with Brucella serology titre of 1:320. He subsequently reported raw camel milk consumption one month prior. MRI demonstrated L5-S1 spondylodiscitis, right glenohumeral joint effusion with synovial thickening, loculated fluid within the LHB tendon sheath, and complete proximal-third LHB tendon rupture. Lumbosacral MRI confirmed spondylodiscitis without epidural abscess or neurological compromise. Spine management was conservative. Arthroscopic shoulder debridement confirmed infective synovitis, yellowish intra-articular fluid, and complete LHB rupture. The patient received intravenous gentamicin, ceftriaxone, oral doxycycline, and rifampicin. At two months, shoulder pain had resolved, range of motion was almost full, back pain had improved, and CRP had normalised with no documented recurrence. This case represents a rare multifocal presentation of osteoarticular brucellosis and highlights the importance of early microbiological investigation in endemic regions when systemic symptoms coexist with severe musculoskeletal pain. Infective tenosynovitis should be considered a potential contributor to tendon rupture in patients with confirmed brucellosis. Multidisciplinary management is essential.
Metrics
References
Corbel MJ. Brucellosis in humans and animals. Geneva: World Health Organization, 2006. Available at: https://iris.who.int/handle/10665/43597?. Accessed on 09 April 2026.
Franco MP, Mulder M, Gilman RH, Smits HL. Human brucellosis. Lancet Infect Dis. 2007;7(12):775-86. DOI: https://doi.org/10.1016/S1473-3099(07)70286-4
Pappas G, Papadimitriou P, Akritidis N, Christou L, Tsianos EV. The new global map of human brucellosis. Lancet Infect Dis. 2006;6(2):91-9. DOI: https://doi.org/10.1016/S1473-3099(06)70382-6
Dadar M, Al-Khaza’leh J, Fakhri Y, Akar K, Ali S, Shahali Y. Human brucellosis and associated risk factors in the Middle East region: a comprehensive systematic review, meta-analysis, and meta-regression. Heliyon. 2024;10(14):e34324. DOI: https://doi.org/10.1016/j.heliyon.2024.e34324
Al-Ani F, Al Ghenaimi S, Hussein E, Al Mawly J, Al Mushaiki K, Al Kathery S. Human and animal brucellosis in the Sultanate of Oman: an epidemiological study. J Infect Dev Ctries. 2023;17(1):52-8. DOI: https://doi.org/10.3855/jidc.17286
Holloway P, Gibson M, Holloway T, Pickett I, Crook B, Cardwell JM, et al. Camel milk is a neglected source of brucellosis among rural Arab communities. Nat Commun. 2025;16:624. DOI: https://doi.org/10.1038/s41467-024-55737-2
Yagupsky P, Morata P, Colmenero JD. Laboratory diagnosis of human brucellosis. Clin Microbiol Rev. 2019;33(1):e00073-19. DOI: https://doi.org/10.1128/CMR.00073-19
Adetunji SA, Ramirez G, Foster MJ, Arenas-Gamboa AM. A systematic review and meta-analysis of the prevalence of osteoarticular brucellosis. PLoS Negl Trop Dis. 2019;13(1):e0007112. DOI: https://doi.org/10.1371/journal.pntd.0007112
Esmaeilnejad-Ganji SM, Esmaeilnejad-Ganji SMR. Osteoarticular manifestations of human brucellosis: a review. World J Orthop. 2019;10(2):54-62. DOI: https://doi.org/10.5312/wjo.v10.i2.54
Pourbagher A, Pourbagher MA, Savas L, Turunc T, Demiroglu YZ, Erol I, et al. Epidemiologic, clinical, and imaging findings in brucellosis patients with osteoarticular involvement. AJR Am J Roentgenol. 2006;187(4):873-80. DOI: https://doi.org/10.2214/AJR.05.1088
Colmenero JD, Ruiz-Mesa JD, Plata A, Bermudez P, Martin-Rico P, Queipo-Ortuño MI, et al. Clinical findings, therapeutic approach, and outcome of brucellar vertebral osteomyelitis. Clin Infect Dis. 2008;46(3):426-33. DOI: https://doi.org/10.1086/525266
Oztekin O, Calli C, Adibelli ZH, Kantarci F, Aydinlioglu A, Sener RN. Brucellar spondylodiscitis: magnetic resonance imaging features with conventional sequences and diffusion-weighted imaging. Radiol Med. 2010;115(5):794-803. DOI: https://doi.org/10.1007/s11547-010-0530-3
Bozgeyik Z, Ozdemir H, Demirdag K, Ozden M, Sonmezgoz F, Ozgocmen S. Clinical and MRI findings of brucellar spondylodiscitis. Eur J Radiol. 2008;67(1):153-8. DOI: https://doi.org/10.1016/j.ejrad.2007.07.002
Horiuchi K, Asakura T, Bessho Y, Saito F. Infectious tenosynovitis of the long head of the biceps caused by methicillin-resistant Staphylococcus aureus in a patient with diabetes and small cell lung cancer. BMJ Case Rep. 2019;12(3):e229040. DOI: https://doi.org/10.1136/bcr-2018-229040
Elzein FE, Sherbeeni N, Alomari A, Alhazzani W, Alsaeed M, Almuneef M. Brucella septic arthritis: case reports and review of the literature. Case Rep Infect Dis. 2016;2016:4687840. DOI: https://doi.org/10.1155/2016/4687840
Chernchujit B, Srimongkolpitak S, Kintarak J, Pornmeechai Y. The role of shoulder arthroplasty after chronic brucellosis of glenohumeral joint septic arthritis: a case report and literature review. Int J Surg Case Rep. 2022;97:107467. DOI: https://doi.org/10.1016/j.ijscr.2022.107467
Tekin R, Ceylan TF, Cevik R. Brucellosis as a primary cause of tenosynovitis of the extensor tendons. Infez Med. 2015;23(3):257-60. DOI: https://doi.org/10.1155/2015/845867
Zangeneh M, Rezvanfar K, Khosravani-Nejad Y, Faghani Y, Dezfulinejad M, Saadat Fakhr M, et al. Infection of tendon sheaths, joints, bursae, soft tissue, and tendon rapture by brucella: a case report. Clin Case Rep. 2023;11(11):e8157. DOI: https://doi.org/10.1002/ccr3.8157
Riley GP. The pathogenesis of tendinopathy. A molecular perspective. Rheumatology (Oxford). 2004;43(2):131-42. DOI: https://doi.org/10.1093/rheumatology/keg448
Chun YM. Arthroscopic treatment of septic arthritis of the shoulder: decision-making for reoperation. Clin Shoulder Elb. 2020;23(1):1-2. DOI: https://doi.org/10.5397/cise.2020.00073
Skalsky K, Yahav D, Bishara J, Pitlik S, Leibovici L, Paul M. Treatment of human brucellosis: systematic review and meta-analysis of randomised controlled trials. BMJ. 2008;336(7646):701-4. DOI: https://doi.org/10.1136/bmj.39497.500903.25
Hasanjani Roushan MR, Soleimani Amiri MJ, Janmohammadi N, Sadeghi Hadad M, Javanian M, Baiani M, et al. Comparison of the efficacy of gentamicin for 5 days plus doxycycline for 8 weeks versus streptomycin for 2 weeks plus doxycycline for 45 days in the treatment of human brucellosis: a randomized clinical trial. J Antimicrob Chemother. 2010;65(5):1028-35. DOI: https://doi.org/10.1093/jac/dkq064
Downloads
Published
How to Cite
Issue
Section
